Nerve Stimulator Eases Chronic Headache

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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

BOSTON -- Patients with intractable headache pain who underwent occipital nerve stimulation reported a marked reduction in severity and frequency within the first month after implantation, researchers said here.

At 1 month, headache pain severity was reduced to 2.8 from a baseline of 9 on a 10-point scale for severity and debilitating pain based on post-hoc testing (P<0.001), reported Jason Gaisford, BS, of the University of Saint Francis in Fort Wayne, Ind., and colleagues.

Frequency of the headaches, recorded at 18.7 per month at baseline, was reduced to 6.3 per month after 30 days (P<0.01), the group stated in a poster presentation at the American Academy of Physician Assistants annual meeting.

Pain scores decreased from an average of 9 to 3.3 after 6 months (P<0.001) and the headache frequency decreased from 18.7 per month to 5.7 per month (P<0.001), they added.

The patients -- 11 women and six men who ranged in age from 35 to 54 (mean age 44.8) -- were treated at a single pain management clinic in the Fort Wayne area.

"Occipital nerve stimulation significantly reduces headache severity and frequency in men and women at this pain managment practice," the group wrote. "Findings support further advances in the use of occipital nerve stimulation for medically intractable headaches."

They pointed out that 23% of U.S. adults complain of chronic recurring headaches and that the cost of treating this condition is estimated to exceed $1 billion annually. Neuromodulation uses electrical stimulation to block pain signals, the authors explained.

They tracked outcomes among 17 patients who were treated with occipital nerve stimulation for severe and frequent debilitating headaches that were not successfully treated by less invasive treatment methods.

To be eligible for stimulator treatment, the patients were required to:

Have failed to get relief from multiple conservative treatments such as nonsteroidal anti-inflammatory agents, triptans, tricyclic antidepressants, physical therapy, and chiropractic treatments.

Have undergone a complete psychological evaluation before the occipital nerve stimulation trial procedure.

Had achieved at least a 50% improvement in headache pain severity after an occipital nerve block using a combination of 4 mg of dexamethasone and 4 cc of 2% lidocaine.

Patients were excluded from the study if they were experiencing untreated drug addiction, had pacemaker implantation, or were medically noncompliant.

In addition to improvements at 1 month, the researchers reported similar results at 3 months, indicating no waning of treatment effect. At 3 months, the average pain scores were 3.1 on the 10-point pain scale, and frequency was 5.8 episodes a month, less than one-third of the frequency at baseline.

When the researchers looked at the outcomes by sex, they found no significant differences in effect.

Gaisford reported one complication in the series: Stimulator leads in one patient migrated away from the occipital nerves between the 3-month and 6-month period post implantation.

Another possible complication can be infection at the site of implantation, pointed out Brandon Short, PA-C in psychiatry at Unity Recovery Group in North Palm Beach, Fla., who was not involved in the study.

"Obviously, this procedure is not for everyone," he told MedPage Today, adding that "I am aware of these treatments for pain management, but not particularly for headache pain."

He cautioned that "as in this study, this kind of treatment should be reserved for those patients with chronic, painful headaches or migraines that have not responded to other medical treatments."

Gaisford and co-authors reported no relevant relationships with industry. Short had no relevant disclosures.

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